In 2017, there were at least 701 attacks on hospitals, health workers, patients, and ambulances in 23 countries in conflict around the world. More than 101 health workers and 293 patients and others are reported to have died as a result of these attacks

The year 2017 was also catastrophic in terms of access to medical and humanitarian aid, as parties to conflict—both state militaries and armed groups—in several countries blocked the passage of aid, putting the health of millions of people at severe risk. Fifty-six health programs were forced to close directly or due to insecurity in 15 countries. That trend continued in early 2018, with the siege and bombing of dozens of hospitals and health facilities in eastern Ghouta in Syria.
The numbers are likely significantly higher, however, because some United Nations (UN) agencies report aggregated data on attacks rather than information on individual incidents.

The violence against health in 2017 once again represents violations of longstanding norms meant to protect the safe delivery of care to people everywhere without discrimination or interference. States have made little progress to protect and respect the provision of and access to impartial health care and to ensure proper investigation into and accountability for violations.

INTRODUCTION AND METHODS

This fifth report by the Safeguarding Health in Conflict Coalition contains information from a wide variety of sources. These include Coalition member Insecurity Insight’s data from the Aid in Danger Security in Numbers Database (SiND); other Coalition members’ data, incident reports supplied to the Coalition by Médecins Sans Frontières (MSF) and the World Health Organization (WHO); reports from other UN agencies, including the Office for the Coordination of Humanitarian Affairs and the Office of the High Commissioner for Human Rights; independent nongovernmental organizations (NGOs); and media reports.

The list of specific events on which this report is based can be viewed on the Humanitarian Data Exchange (HDX). This list only covers individual events, and some reports of events only contained aggregate figures. These aggregate figures are cited in this report but could not be included in the event count. The figures presented in this report can be cited as the total number of events compiled by members of the Safeguarding Health in Conflict Coalition. They provide a minimum estimate of the damage to health care from violence that occurred in 2017. However, the severity of the problem is likely much greater, as many incidents go unreported and are thus not counted here.

The report focuses on attacks on health care in conflict, defined as any act of verbal or physical violence, obstruction, or threat of violence that interferes with the availability, access, and delivery of curative and/ or preventive health services in countries experiencing conflict or in situations of severe political volatility. The report does not cover interpersonal violence directed at health workers, which are prevalent in countries such as China, India, and Mexico, or general criminal violence.
However, in the Central African Republic (CAR), Libya, and Mali, where the ongoing conflict has destabilized society to an extent that it is difficult to distinguish between criminal and politically motivated violence, robberies at health infrastructures are included. In Egypt,
Ethiopia, and Pakistan, care has been taken to only include attacks that can be linked to an existing conflict.

This report is not and cannot be comprehensive because many attacks on and other forms of interference with medical care are never reported. Data are especially lacking on obstruction of access, blockages of transports, and other acts in which health workers and patients are denied passage, threatened, and intimidated. Similarly, arrests of health workers for providing care to people deemed enemies are also often not reported. Lack of access by human rights monitors to areas where attacks took place likely also led to considerable under-reporting of attacks on and interference with health care. Furthermore, in Mali, Ukraine, and Yemen, UN agencies report aggregate numbers of attacks over a particular time period without providing information on each incident. The Coalition welcomes the WHO’s new initiative to collect and disseminate data on attacks on health care, beginning with 11 countries in 2018.

OVERVIEW

The countries with the most reported acts of violence on health infrastructure and against health workers and patients are Afghanistan (66), the CAR (52), the Democratic Republic of Congo (DRC) (20), Iraq (35),
Nigeria (23), occupied Palestinian territory (oPt) (93),
Pakistan (18), South Sudan (37), Syria (252), and Yemen (24).

At least 29 ambulances were damaged or destroyed and 21 hijacked or stolen throughout 2017. In total, 91 health workers were arrested. No breakdown of the figures is currently available for Syria.

In addition, oPt had the most reported obstruction to the provision of health care, with 57 detailed cases.
In Ukraine, the parties to the conflict shelled health facilities, blocked the passage of ambulances, and impeded patients from crossing the “contact line,” which divides Ukrainian and separatist-controlled territories, to seek health care.

Severe and devastating obstruction of medical and humanitarian aid has deprived millions of people of access to medicine and health care in Myanmar, South Sudan, Sudan, Syria, and Yemen.

Although there were fewer reported instances of violence against vaccinators than in past years, in 2017, vaccinators continued to be attacked in Afghanistan, Nigeria, Pakistan, Somalia, and South Sudan for seeking to immunize children against polio. For example, in Nigeria, an army plane dropped two bombs on an internally displaced persons camp near the town of Rann during a vaccination campaign, killing at least 90 people, including at least six Red Cross aid volunteers and three MSF contract workers; the army claimed that the bombing was accidental.